Showing 17 results for KHORSANDI
Marzieh Akbar Zadeh, Mahboubeh Khorsandi,
Volume 2, Issue 6 (Spring 1999)
Abstract
In order to accessing the factors which affect the incidence of unwanted pregnancy, a descriptive study was done in the city of arak and Rural area in 1995.From the total numbers of unwanted pregnancy (761) 235 of them was in the villages and 132 cases 56.2% was unwanted. The results revealed that there is a significant relation between socioeconomic status, education and parity (p<0.001). The most common method was contraceptive pills in rural area (53.7) and the most important source of receiving information was health house. There is a significant relation between the duration of using contraceptive and unwanted pregnancy (p<0.001). The most common cause that women avoid to use of contraceptive methods was fear from complication of oral contraceptive 34.5%, irregular use of missing 25.8% and husband disagreement 24.4%.
Mahboobeh Khorsandi, Sharare Khosravi,
Volume 5, Issue 1 (Spring 2002)
Abstract
Introduction: Clinical education is the most important part of nursing and midwifery education. It is recognized as the heart of professional education. Clinical education includes more than half of nursing and midwifery education and is the base of acquired professional skills in students. So to improve the quality of clinical education its condition must be considered.
Materials and Methods: This is a descriptive- analytic study to investigate the view of nursing and midwifery students about clinical education condition. The sample was all of nursing and midwifery students in their fourth semester of education. The data was collected using a questionnaire consisting of five parts: demographic characteristics, educational planning, clinical education instructor, the health and medical care team and educational equipment and space.
Results: The results showed that most of the students view on educational planning was good and moderate (each 38.2%), on clinical instructor was moderate (34.4%). On health and medical care team was bad (50%), and on educational equipment and space was good (37.2%). The comparison of nursing and midwifery students view showed that there was no significant difference on educational planning, clinical instructor and educational equipment and space.
Conclusion: Educational program planners have to consider important factors affecting clinical education, specially the health and medical care team and their way of acting, who the majority of the sample of this study had a negative view on them.
Mahbube Khorsandi, Fazlallah Ghofranipour, Alireza Heydarnia, Soghrat Faghihzadeh, Maryam Vafaei, Firouzeh Rousta, Farkhonde Aminshokravi,
Volume 11, Issue 3 (9-2008)
Abstract
Background: There has been an increase in the number of women willing to have a caesarean birth because of their fear of childbirth. It seems the childbirth preparation educational class is a good way to remove or alleviate fears associated with pregnancy and childbirth.This research designed to identify the effect of childbirth preparation classes on childbirth fear on the primiparous women. Methods and Materials: The present study is a clinical trial which was carried out in 2007 at Milad Hospital, with 100 nulliparous pregnant women. Childbirth fear was measured by childbirth attitudes questionnaire. Normal pregnant women in the second trimester with childbirth fear score was 28 or more were randomly selected and dirided into experimental and control group with 50 subject in each qroup. The experimental group attended nine childbirth preparation class sessions and control group received routine antennal care. Results: The mean scored fear of childbirth in case and control group were 39.35±6.96 and 40.71±6.23 respectively. There was not significant difference between two groups. After the sessions, comparing childbirth fear score between two groups in third trimester showed the mean score of childbirth fear among experimental group was lower than control group (29.82+/- 7.18 compare to 38.03+/-9.27), and the differences statistically was significant (p<0.001). Mode of delivery was significantly different between the two groups. Conclusion: Primiparous women attended childbirth preparation classes acquired lower score of childbirth fear in compare to women received routine prenatal care. The results of this research showed relaxation training decreased childbirth fear and increased normal vaginal delivery.
Mahbobeh Khorsandi, Farzaneh Jahani, Mohhammad Rafiei, Aliasghar Farazi,
Volume 13, Issue 1 (4-2010)
Abstract
Background: This study was designed to investigate the quality of life in staff and hospital personnel of Arak University of Medical Sciences and to gain basic information for carrying out interventions for improving their quality of life. Materials and Methods: This cross-sectional study was done to determine quality of life of 300 staff and hospital personnel in Arak University of Medical Sciences. Data gathering tools were demographic and standard quality of life (SF-36) questionnaires. Results: Of the 275 participants who had completed the questionnaires, 127 (%46.2) were staff and 148 (%53.8) were hospital personnel. The means of age and years of experience were 36.797.02 and 12.297.39 years, respectively. The mean of different dimensions of quality of life in the staff was significantly much higher than that in the hospital personnel (p<0.05). In terms of physical performance, vitality, social performance, general health, physical and mental health domains, significant differences were found among personnel with different employment status. There was also a significant difference between men and women in terms of physical restriction factors, physical agony, vitality, sanity, mental and physical health. Conclusion: The mean of different dimensions of quality of life in hospital personnel was lower than the staff while this value was lower in women than men. Specific longitudinal studies are needed for investigating the causes of these differences.
Samaneh Ghooshghianghoobmasjedi, Mohsen Dehghani, Mahboobeh Khorsandi, Vali-Allah Farzad,
Volume 14, Issue 3 (7-2011)
Abstract
Background: The UN report on the 41% increase of cesarean labor and its risks in Iran in recent years on the one hand and its association with cognitive and psychological factors on the other motivated us to identify the involving variables so as to control unnecessary cesarean sections. The aim of this study was to investigate the role of fear of pain and related psychological variables (pain catastrophizing, catastrophic cognition, childbirth attitude, depression-anxiety-stress, and experience of pre-menstruation (PMS) in prediction of cesarean labor.
Materials and Methods: In this cross-sectional study, 300 pregnant women from Atieh private and Shahid Akbar Abadi public Hospitals (150 participants from each) were selected and matched by variables, such as age, level of education, month of pregnancy, previous experience of deliveries, tendency to cesarean, type of hospital, and having PMS. To collect data, a battery of questionnaires, including fear of pain, pain catastrophising, catastrophic cognition, childbirth attitude, and depression-anxiety-stress (DASS) were used. The results were analyzed through correlation coefficient and logistic regression.
Results: Education, previous experience of deliveries, month of pregnancy were not significant but such variables as the tendency to cesarean, type of hospital, and age were significant (P<0.05). Such variables as pain catastrophizing, catastrophic cognition, and childbirth attitude were significant but other variables, including fear of pain , depression-anxiety-stress, experience of PMS were not significant (P>0.05).
Conclusion: Such variables as the experience of cesarean, type of hospital, and age as well as pain catastrophizing, childbirth attitude, and catastrophic cognition are significant variable in prediction of cesarean labor in pregnant women.
Mahbobe Khaton Ghanbari, Mohsen Shamsi, Ali Asghar Farazi, Mahbobe Khorsandii, Babak Eshrati,
Volume 16, Issue 7 (10-2013)
Abstract
Background: Survey and control of nosocomial infections in the world is a global priority that The objective is to minimize infections in addition to decreased length of hospitalization And also significantly reduce the cost of health care .The aim of this study was evaluating the knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection.
Materials and Methods: This Cross-sectional and analytical study that was carried out on 130nursing staff selectedin in Arak university of medical sciense in 2013. Data collected with validity and reliebility questionnaire including of knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection. Data was analyzed by using descriptive and analytical statistical methods and pearson correlation.
Results: The mean knowledge was 46.92±14.66 and Practice 49.46±6.96 and average self-efficacy was 52.2±10.81 about infection prevention. There was not significant relationship between knowledge and Practice. But there was a significant relationship between self-efficacy, knowledge and Practice and marriage. Moreover there was a significant relationship between knowledge and gender. (p<0.05).
Conclusion: Despite moderate self-efficacy majority of Nurses do not have appropriate knowledge about prevention of nosocomial infection based on the findings of this study. Considering the important role of nurses in nosocomial infection prevention, training is necessary to increase nurses prevention behaviors. Therefor paying more attention by authorities to apply the necessary actions for training of nurses.
Maryam Fathi Shykhi, Mohsen Shamsi, Mahboobeh Khorsandi, Mehdi Ranjbaran,
Volume 18, Issue 1 (4-2015)
Abstract
Background: Accidents and injuries one of the main causes of death and disability in the world and the most significant causes in children referred to hospital. So, this study aimed to assess the health belief model constructs and function of the mothers referred to health centers in the city of Khorramabad in the preventive behaviors of accidents and injuries in children.
Materials and Methods: This cross sectional and analytical study was done on 261 mothers with children aged less than 5 years are referred to health centers in the city of Khorramabad in 2014. Data was collected with a questionnaire based on the Health Belief Model. The data collected were analyzed by software SPSS-20.
Results: In this study the mean and standard deviation of age of mothers was 28.98±5.37 years and the mean score of function and self-efficacy were 59.1±14.74 and 69.1±11.07 respectively. Moreover, the mean scores of the other health belief model constructs such as perceived sensitivity, severity, benefits and barriers was higher than average. There was significant negative correlation between self-efficacy and perceived barriers (r=-0.256, p<0.01), and also between the perceived barriers and function (r=-0.391, p<0.01).
Conclusion: According to the score of the function of mothers and the other constructs of health belief model, training programs based on the model directly and indirectly in the form of multimedia training package recommended to promote preventive behaviors of accidents occur in children.
Tahereh Razi, Mohsen Shamsi, Mahbobeh Khorsandi, Nasrin Roozbehani, Mehdi Ranjbaran,
Volume 18, Issue 7 (10-2015)
Abstract
Background: M others must gain enough knowledge and practice about danger signs in children to achieve behavior change. Knowing such factors influencing behavior change will facilitate change. So, training about danger signs in children using models that identify the factors influencing behavior is essential. Health belief model is one of the effective models in education. Therefore, the aim of this study was to assess the effect of education on behavior of mothers about danger signs in children less than five years.
Materials and Methods: This is an educational trial study that was conducted on 116 mother with children under five years old referring to treatment health centers in Arak city in 2014. They were divided into two groups case (n=56 ) and control ( n=60 ) randomly.
The data collected by filling the valid and reliable questionnaire that reseatcher made along with interview. An educational intervention was conducted in case group during the four learning sessions. Three months after educational intervention, post-test was conducted by filling questionnaire. Finally, data were analyzed by SPSS software in significance level of p<0/05.
Results: There was no significant difference between mean score of health belief model construct and behavior in the experimental and control groups before the intervention(p<0.05) , but significant differences were shown after intervention(p<0.001). The mean score of the mothers in the intervention group before and after intervention was 39.58±42.15, and 84.52±23.05 respectively, that showed significant differences (p<0.001).
Conclusion: According to the results of this study, educational intervention based on initial assessment on Health Belief Model was effective in improving mothers' practice about danger signs in children. Thus, it can be helpful to design training programs.
Somaye Pormosayebi, Mohsen Shamsi, Mahbobeh Khorsandi, Ali Kolivand, Mehdi Ranjbaran,
Volume 18, Issue 8 (11-2015)
Abstract
Background: Today, environmental pollutants are one of the most important human problems. The purpose of this study was to assess the health belief model structures for promotion of preventive behaviors in pregnant women exposed to air pollution in Arak city in 2014.
Materials and Methods: In this cross-sectional study, 208 pregnant women referred to healthcare centers in Arak city were selected by multistage sampling and were studied. Data were collected by using a valid and reliable self- report questionnaire. The questionnaire included the demographic characteristics of the mother, the aspects of the HBM model, and the maternal practice checklist. Finally, the data were analyzed.
Results: The mean age of subjects was 26.48 ±4.77 and the mean gestational age was 14.88 ±5.59 weeks. The highest level of education for pregnant women (47.1%) was a diploma. The mean practice score was 72.9 and among the structures, the highest and the lowest score was obtained for perceived susceptibility(83.25) and barriers(59.16), respectively. To predict the hehavior by using the HBM structures, regression analysis showed that of the studied variables, the external practice guides, perceived susceptibililty, and barriers are as behavior predictive predictive agents that totally, predicted 26% (R2=0.265) of behavior changes.
Conclusion: According to the results of the study, the design of educational interventions should be based on the external practice guides, perceived susceptibility and barriers structures as the most important predictors of maternal behavior.
Seydeh Mahtab Navabi, Mahboobeh Khorsandi, Nasrin Roozbahani, Mehdi Ranjbaran,
Volume 18, Issue 10 (1-2016)
Abstract
Background: One of the common and important public health problems is failure to thrive in during childhood .The purpose of this study was to investigate the relationship between health belief model structures with mothers' performance in preventihg growth retardation in children aged 1-5 years in Shazand city in 2014.
Materials and Methods: In this analytical and cross-sectional study, 202 mothers with children aged one to five years in the Shazand city were selected by random sampling. The data were collected by using a researcher-developed valid and reliable questionnaire by self-report method. The questionnaire included demographic characteristics of the mothers, the maternal practice cheklist and health belief model dimensions. Finally, the data were analyzed by SPSS20 T-test, Chi-square, correlation, ANONV and regression.
Results: The mean age of subjects was 28.76±5.28 years and a mean age of children was 26.49±14.74 months. Most common level of education for mothers was diploma (76.7%). The mean score of mothers' behavior was 70.65. Among the structures, self- efficacy had the largest score(69.8) and external practice guide had the lowest (38.91). In regression analysis, for predicting behavior by health belief model stuctures, self efficacy, perceived benefits and barriers were main predictors of behavior that predicted 10% of behavior changes(R2=0.101).
Conclusion: The results of this study reveale that the design of educational interventions should be based on self-efficacy, perceived benefits and perceived barriers as the most important predictors of maternal behavior.
Faezeh Barati, Mohsen Shamsi, Mahboobeh Khorsandi, Mehdi Ranjbaran,
Volume 18, Issue 11 (2-2016)
Abstract
Background: Today, the consumption of junk food as a snack among children, especially in elementary school students is on the rise. This research has measured Theory of Planned Behavior constructs in this field.
Materials and Methods: This is a cross-sectional and analytical study that was carried out on 217 primary school students in Arak city in 2015. Students were selected according to cluster sampling method. Data collection instrument was a researcher-developed questionnaire consisting of theory of planned behavior constructs such as attitudes, subjective norms, perceived behavioral control, behavioral intention and performance. Reliability and validity of the questionnaire was studied before the study. Multivariate linear regression model was used to determine the most important predictive constructs of students behavior.
Results: In this study, the mean and standard deviation score of attitude (75.41±12.42), subjective norm (78.25±11.20), perceived behavioral control (63.69±17.06), behavicral intention (76.26±15.44), and performance (48.84±24.44) were observed. Based on the results, perceived behavioral control could predict 23 percent change in behavior. There was a direct correlation between the score of constructs and performance(p<0.05). Moreover, there were not any significant differences(p>0.05) between students nutrition and age(r=0.019), weight (r=0.07), height (r=0.12) and BMI (r=0.07).
Conclusion: The results of this study suggested that positive attitude and self-esteem must taken into account to control students diet, in the design of interventions to prevent consuming junk food.
Azita Mohsennejad, Mahboobeh Khorsandi, Nasrin Roozbahani, Babak Eshrati,
Volume 19, Issue 1 (4-2016)
Abstract
Background: Improvement of nutrition like fish and sea products is influential in preventing from non-contagious diseases. The transtheoretical model is one of the models for effective investigation on nutrition behaviors. This study was done with the aim of investigating fish consumption among women 30 to 50 years old based on the transtheoretical model.
Materials and Methods: This study was an analytical and cross sectional analysis which was conducted in 2014 on 360 women 30 to 50 years in Arak city. The data have been collected by using researcher-made questionnaires which its validity and reliability was assessed in accordance to the transtheoretical model were obtained by visiting houses. Then the collected data were analyzed by pearson correlation test.
Results: The average age of the respondents was 39.34±7.5. The average of fish consumption was 0.62 ±0.83 times a week. 64 % of people in consumption of at least two servings of fish a week were in the two first stages of change (pre-contemplation and contemplation).The average score of self-efficacy in fish consumption was a total of 10.58 ±3.12 out of 15 and the average score of cons of fish was 26.35 ±4.78 and the average score of pros of fish was 21.6 ±2.67 out of 25. Pearson correlation indicates that the amount of fish consumption with constructs of the self-efficacy, stages of change and pros of fish had respectively the most positive correlation (p≤0.05). Fish consumption had no significant difference with age, education, Body Mass Index, occupation, monthly income and marital status.
Conclusion: Fish consumption despite its high level of perceived benefits is really low and to eliminate these barriers, education and cultural-building especially in women who are influential people in family nutrition is necessary.
Fahimeh Farahani Dastjani, Mohsen Shamsi, Mahboobeh Khorsandi, Mohammadreza Rezvanfar, Mehdi Ranjbaran,
Volume 19, Issue 2 (5-2016)
Abstract
Background: Diabetes is one of the most common disease resulted from metabolism disorders. Thus, Studying medication adherence in patients to explain educational interventions to improve the health of these patients is necessary. Therefore, the present study aimed to assess the factors affecting medication adherence in diabetics patients based on health belief model in Arak 2014.
Materials and Methods: In this analytical study, 366 diabetic patients in Arak in 2014 were selected and data were collected through a researcher made questionnaire about patients behavior in the field of medication adherence and its influencing factors based on the health belief model. Linear regression model was used to determine the predictive power of structures.
Results: The mean knowledge score and the medication adherence was 31.34 and 84.34, respectively. In this study, perceived susceptibility, perceived barriers and internal action guide were as the strongest predictors of medication adherence behavior in patients and predicted their behavior variance 0.36. Between function and susceptibility and severity and perceived benefits and self- efficacy of manual internal and external action guides in the field of medication adherence with diabetes, there was a direct correlation that the highest correlation was related to the perceived susceptibility structure (r=0.42 , p<0.001).
Conclusion: The results showed that the educational interventions with an emphasis on building the perceived sensitivity of patients with diabetes for medication adherence and emphasis on internal incentives as motivators and incentives for patients to achieve better results in the field of medication adherence should be at the heart of educational interventions.
Mahtab Navabi, Mahboobeh Khorsandi, Nasrin Rouzbahani, Mehdi Ranjbaran,
Volume 20, Issue 1 (4-2017)
Abstract
Abstract
Background: One of the common and important health problems is failure to thrive in childhood. The purpose of this study was to determine the effect of education on preventive behaviors of failure to thrive in mothers with children based on health belief model.
Materials and Methods: This study is an interventional one in which 100 mothers with children one to five years involved (samples divided into two case and control groups, each of 50) sampling was done by a simple random method. For collecting information, a researcher-made questionnaire based on the health belief model and performance check list were used. Then, case group was trained for one month. 3 months after training, data were gathered and analyzed by Spss20 software. In addition to descriptive statistics, tests such as Chi-square, paired t-test and independent T-test were used.
Results: The mean age of case and control was 29.98±5.51 and 25.35±5.30 years old, respectively. The average age of children was 23.31 ± 13.14 and 27.55 ± 14.01months, respectively. Before the intervention, no significant difference was seen between groups. The average score in case group before intervention was as: knowledge(31.87±14.24), perceived susceptibility(64.23±5.86), perceived severity(64.41±9.34), perceived benefits(61.75±6.79), perceived barriers(67.91±8.14), self-efficacy(68.00±7.87), cues to action(44.53±6.82) and action(70.00±9.77). However, after the intervention, significant differences between groups in all variables were obserred.
Conclusion: According to the results, education based on health belief model is recommended for promoting preventive behaviors of failure to thrive.
Zahra Jahangiri, Mohsen Shamsi, Mahboobeh Khorsandi, Rahmatollah Moradzadeh,
Volume 21, Issue 5 (10-2018)
Abstract
Background and Aim: Iron deficiency is one of the most common nutritional problems during pregnancy. The purpose of this study was to assess the theory of planned behavior structures on nutritional prophylactic treatment of anemia in pregnant women of Arak city in 2018.
Materials and Methods: This is a cross-sectional study that was carried out on 199 pregnant women in Arak city using simple random sampling in 2018. The data were gathered with valid and reliable researcher-made questionnaire including demographic information and the theory of planned behavior structures. The study was conducted to determine the most important predictive constructs of pregnant womens’ behavior using a multivariate linear regression model.
Findings: The finding showed that mean age of mothers was 28.81 ± 5.1 years and the mean weekly gestation was 28.04 ± 8.9 weeks and the gestational interval with previous pregnancy was 5.18 ± 3.9 years. Mean±standard deviation of attitude score (3.61 ± 0.62), subjective norm (3.60 ± 0.74), perceived behavior control (3.50 ± 0.58), behavioral intention (3.49 ± 0.61), performance (3.55 ± 0.76) and awareness (0.57±0.2) were observed. Linear regression model showed that the performance score of pregnant women improved for each unit of attitude and subjective norms and perceived behavioral control, respectively, by 0.463, 0.343 and 0.347, respectively.
Conclusion: The results emphasize the provision of educational programs on the prevention of anemia in pregnant women with an emphasis on attitudinal structures, mental norm, and perceived behavioral control. It is suggested that at the time of designing interventions to improve the prevention of anemia in pregnancy, the structures of the theory of planned behavior should be considered.
Zahra Jahangiri, Mohsen Shamsi, Mahboobeh Khorsandi, Rahmatollah Moradzade,
Volume 23, Issue 6 (February & March 2020)
Abstract
Background and Aim: Iron deficiency is among the most prevalent nutritional problems during pregnancy. Besides, it can significantly affect pregnant women’s health. Therefore, this study aimed to determine the effect of education based on the Theory of Planned Behavior (TPB) on promoting anesthetic prevention nutritional behaviors in the pregnant woman.
Methods & Materials: This was an educational randomized controlled trial study. In total, 80 pregnant women were randomly divided into two groups of test and control (n=40/group). Data collection with reliable and validity questionnaire consist of demographic factors, knowledge, the construct of TPB (attitude, subjective norms, perceived behavior control, intention), and performance. Before performing the intervention, pre-test data were collected from the study groups. Then, the educational intervention was performed based on the results of the needs assessment for the test group, within a month and in the form of four 60-minute training sessions based on the TPB. The results were collected 3 months after the intervention and analyzed using the Mann-Whitney U test, Chi-squared test, and correlation coefficient.
Ethical Considerations: The present study was registered with the code IRCT2017052334106N1 in the Clinical Trial Registration Center of Iran and was approved by the Research Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1395.445).
Results: The present research results indicated that before the intervention, all variables were the same in the study groups. However, after the intervention, the research groups significantly differed concerning all the studied structures (P<0.05). Moreover, the Mean±SD pre-test performance score of the intervention group was equal to 2.88±0.415 (out of 5); accordingly, it was significantly improved after training to 3.64±0.216 (P<0.001).
Conclusion: Educational intervention based on the TPB improved anesthetic anxiety behaviors in the studied pregnant women; such a modification can be attributed to the provided educational program in the intervention group.
Mr Mohsen Shamsi, Mr Ali Kulivand, Mr Mohammadjavad Ghannadzadeh, Ms Mahboobeh Khorsandi, Mr Seyedhamed Mirhosseini, Mr Amir Almasi-Hashiani, Mr Behrooz Karimi, Mr Seyednadali Alavi Bakhtiarvand, Ms Masoume Naderi Noreyni,
Volume 25, Issue 4 (October & November 2022)
Abstract
Introduction: Today, with the increase in population, the per capita production of waste materials and the subsequent threat and destruction of the environment is an increasing process, and waste management by the people of a society can play an essential role in reducing this problem. Therefore, the aim of this study was determine of predicting the waste management behaviors of households in Arak city in 2022.
Methods: This is a cross-sectional and analytical study that was carried out on 600 mothers of households in Arak city, who were selected by multi-stage sampling. The data collection tool was a valid and reliable researcher-made questionnaire that included demographic characteristics, knowledge, attitude and behavior of households in the field of waste management. Data were analyzed using SPSS software and t-test, chi-square and regression tests. This study was approved by the research ethics committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1401.040).
Results: The average age of the studied was 39±11 years and the number of family members was 3.6. In terms of type of housing, most of them lived in apartments (44%) and a smaller number lived in complexes (14%). 65 percent of the people had not received the training on the waste separation plan from the source, and among the effective training methods, the majority (38 percent) of the people had overestimated the effectiveness of the training through the Internet. The mean and standard deviation of knowledge was 66±19, attitude was 84±11 and performance was 73±18. The majority of the people studied had a good level of awareness and attitude. The regression analysis model showed that the greatest impact on the waste management behavior of the samples was the age of the people, their knowledge and attitude, which predicted a total of 33% of the waste management behavior.
Conclusions: Considering the favorable state of awareness and attitude of households in Arak city, it seems that for better waste management, other environmental factors should be emphasized, including sources of waste production at the source. Also, based on the prediction model, it is still important to inform and change the attitude of households in Arak city for better performance at younger ages.
